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Rehabilitation Considerations in the Management of Terrible Triad Injury to the Elbow

Pipicelli, Joey G. MScOT, OT Reg. (Ont.), CHT*,†,‡; Chinchalkar, Shrikant J. M.Th.O., BScOT, OTR, CHT*,†,‡; Grewal, Ruby MD, FRCSC†,‡,§,∥; Athwal, George S. MD, FRCSC†,‡,§,∥

Techniques in Hand & Upper Extremity Surgery:
doi: 10.1097/BTH.0b013e31822911fd
Techniques
Abstract

An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. This injury almost always renders the elbow unstable requiring surgical intervention. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Recent literature has improved our understanding of elbow anatomy and biomechanics as well as the pathoanatomy of this injury. This article reviews key concepts that will allow the surgeon and therapist to apply an systematic rehabilitation approach when managing such injuries.

Author Information

*Division of Hand Therapy

Hand & Upper Limb Centre

§Division of Orthopaedics

The University of Western Ontario

St. Joseph’s Health Care, London, Ontario, Canada

Conflicts of Interest: Joey G. Pipicelli is a hand therapist, Hand and Upper Limb Centre, St. Joseph’s Health Care, London, Ontario, Canada. Neither Mr. Pipicelli nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Shrikant J. Chinchalkar is a hand therapist, Hand and Upper Limb Centre, St. Joseph’s Health Care, London, Ontario, Canada. Neither Mr. Chinchalkar nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Dr. Ruby Grewal is Assistant Professor of Surgery and Consultant Elbow, Wrist, and Hand Surgeon, Hand and Upper Limb Centre, St. Joseph’s Health Care, University of Western Ontario. Neither Dr. Grewal nor a member of her immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Dr. George S. Athwal is Assistant Professor of Surgery and Consultant Shoulder and Elbow Surgeon, Hand and Upper Limb Centre, St. Joseph’s Health Care, University of Western Ontario. Neither Dr. Athwal nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Address correspondence and reprint requests to Joey G. Pipicelli, MScOT,OT Reg. (Ont.), CHT, Division of Hand Therapy, Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario, Canada, N6A 4V2. E-mail: Joey.Pipicelli@hotmail.com; Joey.Pipicelli@sjhc.london.on.ca.

© 2011 Lippincott Williams & Wilkins, Inc.